Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding.
Gastroenterology. 2019 Sep 26;:
Authors: Niikura R, Nagata N, Yamada A, Honda T, Hasatani K, Ishii N, Shiratori Y, Doyama H, Nishida T, Sumiyoshi T, Fujita T, Kiyotoki S, Yada T, Yamamoto K, Shinozaki T, Takata M, Mikami T, Mabe K, Hara K, Fujishiro M, Koike K
BACKGROUND & AIMS: We performed a large, multicenter randomized controlled trial to determine the efficacy and safety of early colonoscopy on outcomes of patients with acute lower-gastrointestinal bleeding (ALGIB).
METHODS: We performed an open-label study, at 15 hospitals in Japan, of 170 patients with ALGIB randomly assigned (1:1) to groups that underwent early colonoscopy (within 24 hrs of initial visit to the hospital) or elective colonoscopy (24-96 hrs after hospital admission). The primary outcome was identification of stigmata of recent hemorrhage (SRH). Secondary outcomes were rebleeding within 30 days, endoscopic treatment success, need for transfusion, length of stay, thrombotic events within 30 days, death within 30 days, and adverse events.
RESULTS: SRH were identified in 17/79 patients (21.5%) in the early colonoscopy group vs 17/80 patients (21.3%) in the elective colonoscopy group (difference=0.3, 95% CI, -12.5 to 13.0; P=.967). Rebleeding within 30 days of hospital admission occurred in 15.3% of patients in the early colonoscopy group and 6.7% of patients in the delayed colonoscopy group (difference=8.6, 95% CI, -1.4 to 18.7); there were no significant differences between groups in successful endoscopic treatment rate, transfusion rate, length of stay, thrombotic events, or death within 30 days. The adverse event of hemorrhagic shock occurred during bowel preparation in no patient in the early group vs 2 patients (2.5%) in the delayed colonoscopy group.
CONCLUSIONS: In a randomized controlled study, we found that colonoscopy within 24 hrs after hospital admission did not increase SRH or reduce rebleeding compared with colonoscopy at 24-96 hrs in patients with ALGIB. ClinicalTrials.gov no: UMIN000021129 and NCT03098173.
PMID: 31563627 [PubMed - as supplied by publisher]